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1、最新Download-CarcinoidandPancreaticNeuroendocrineCancer：下载-类癌和胰腺神经内分泌癌-药学医学精品资料ObjectivesReviewthedefinitionofpainandbasicpathophysiologyReviewthecommoncausesofpainincancerpatientsReviewapproachtomanagingpainDefiningPainPainisdefinedasanunpleasantsensoryandemotionalexperienceassociatedwit
2、hactualorpotentialtissuedamage,ordescribedintermsofsuchdamage.Merskey,H.,Bogduk,N,ed.ClassificationofChronicPain,SecondEdition.IASPTaskForceonTaxonomy.1994,IASPPress:Seattle.209-214.NociceptivePainNociceptivesomaticpainSustainedpredominantlybytissueinjuryorinflammation.Describedassharp,
3、aching,stabbing,throbbingorpressure-like.NociceptivevisceralpainPoorlylocalized;describedascrampypain(e.g.obstructionofhollowviscus),orasachingandstabbing(e.g.painsecondarytosplenomegaly).NeuropathicPainSustainedbyabnormalsomatosensoryprocessinginthePNSorCNS.Typically,describedas“burnin
4、g,”“shock-like,”“electrical.”Maybeparoxysmalinnature.Onphysicalexamination,patientsmayhaveallodynia(paininducedbynon-painfulstimuli)andhyperalgesia(increasedperceptionofpainfulstimuli).PsychogenicPainReferstopainthatisbelievedtobesustainedpredominantlybypsychologicalfactors.Rareinthecan
5、cerpopulation.IdiopathicPainIntheabsenceofevidencesufficienttolabelpainaseithernociceptiveorneuropathic,wemayusetheterm“idiopathic.”Inpatientswithcancer,thistermshouldleadtoadditionalworkupandasearchforanunderlyingetiologyandpathophysiology.BasicPathophysiologyofPainTransductionConversi
6、onofthermal,chemical,mechanicalstimulustoelectricalactivityatnociceptorNachannelsConductionPassageofactionpotentialalongthefirstorderneurontodorsalhornofspinalcordTransmissionTransferandmodulationofinputfromoneneurontoanotherSubstanceP,Glutamate,BrainderivedneurotropicfactorInhibitoryin
7、terneuronsPerceptionAwarenessandmeaningofpainModulationDescendingpathwaysinhibittransmissionofnociceptiveimpulsese.g.Periaqueductalgreymatterinmidbrain-->nucleusraphaeinmedullaNorepinephrine,serotonin,endogenousopioidsAscendingTractsDescendingTractsCortexMidbrainMedullaSpinalCo
